I have already had turbinate reduction surgery and septoplasty, which has completely opened up my sinuses. I breathe freely through the nose for the first time in my life. However, I still have severe sleep apnea. My first test was at 105 AHI (!) My second test was at 68 AHI. I have been on APAP for a couple months. My apnea is reduced, but not eliminated. With APAP my AHI is usually between 15 and 20. Better than without APAP, but not good enough. I have an appointment to talk to the doc about more surgery options, but I want to go in with some knowledge. We've already played with pressure, ramping, etc, and determined I may need more surgery, thus the appointment. I am not significantly overweight, so weight loss won't help in my case. What options might there be for my situation? Note that I still have my tonsils/adenoids/uvula and I suspect that's the next step the doc will want to take. I am guessing there are more options. Since I am with an HMO, they might have a tendency to not mention more expensive options. I am looking for the highest chance of improving my AHI, for the moment without regard to cost or recovery (I'll discuss those things with the doc).

I'm not just fiddling with knobs. I have been doing this with the sleep center for three months. Four different masks. My apnea is too severe. I need to at least reduce my AHI to a level that the APAP machine can handle.

So what are your pressure settings now that are giving your the AHI of 15 to 20 and what is the event category breakdown of the AHI?How much in each category...central, obstructive, hyponea?It's real important to know exactly what you are trying to fix before searching for fixes.If your AHI is predominately central in nature...no amount of cutting will help.

Have you downloaded SleepyHead? You might want to post some charts for people to take a look. Diamaunt's signature line has the info you would need to download and organize your charts before posting. I wouldn't say your apnea is too severe, you said your second study had you at 68. My avg. AHI was 84 during my sleep study and I consistently get an AHI under 2.0 now (just as a reference, not comparing my situation to yours). It could be that you need a different type of machine.

On the left side hide the calendar and turn off the pie chart (Preferences/Appearance tab) so that the statistics move into view.

On the right side just these graphs.EventsFlow ratePressureLeakDon't need any other graphs.Graphs can be moved and resized easily so you can get all you need in one image.

So you end up with AHI and machine settings and statistics on the left and 4 graphs on the right looking like this.I didn't hide the calendar on this one but it's all I could find as and example quickly.

Okay with Flex set to 3 on a Respironics machine the maximum reduction available during exhale is 2 cm.It's not a huge amount of pressure support (pressure support is simply the difference in pressure between inhale (IPAP) and exhale (EPAP))Sometimes for some people...very small number of people...the fact that there is a difference between inhale and exhale can cause a bit of breathing instability that ends up affecting the carbon dioxide levels (doesn't let them get high enough to tell the brain to send the breathe stimulus).

People sometimes think it is low oxygen levels that trigger the brain to tell the body to breathe but it's actually the carbon dioxide levels in the brain...they need to be up to where ever they need to be or high enough so the brain knows to tell the body to breathe.

When the brain doesn't send the "breathe" stimulus then we don't inhale or exhale. We do nothing. Hold your breath for 10 seconds....that's pretty much what a central apnea is. The airway is open but there is no air flow because you are holding your breath.

Sometimes pressure support will cause a little breathing instability and cause too much carbon dioxide to get blown off before it reaches a level in the blood stream for the brain to send the trigger to breathe...so the central apnea happens.

Now why this can happen(PS causing centrals) for a really rare number of people I don't know all the mechanics behind it. It just does.

Are you one of those people? Don't know but it's worth turning Flex off and see if it makes any difference in the number of centrals you are seeing. You might get lucky and have the centrals pretty much disappear...or you might not and then we get to have the other discussion about the other type of machine.

You've been on some form of cpap therapy for quite some time haven't you????? Over 6 months????

You cannot post new topics in this forumYou cannot reply to topics in this forumYou cannot edit your posts in this forumYou cannot delete your posts in this forumYou cannot post attachments in this forum